Minimal data exists on the prevalence of gastroesophageal reflux disease in minority populations. Specific objectives of this K24 research project are to: (1) Provide an estimate of the prevalence of gastroesophageal reflux disease in an urban, African American population; (2) Determine whether specific risk factors including diet, tobacco use, physical activity, and psychosocial stress are important in the targeted population. We will also measure height, weight, and waist/hip circumference to determine the impact of central obesity on reflux; (3) To identify the importance of race and identify risk factors for gastroesophageal reflux disease unique to the African Americans population by using a control group composed of Caucasians; (4) Study the effects of weight loss by behavioral modification on reflux symptoms in African Americans. Our methods for objectives 1-3 will be a carefully designed survey of the community surrounding Temple. For objective 4 we will perform a randomized, controlled trial of individuals with reflux disease and obesity. All subjects will undergo esophageal physiological esting and complete detailed questionnaires assessing diet, physical activity, quality of life, and medication use. One group will undergo a calorie-restricted diet associated with a standardized behavioral modification program. The other group will eat ad lib. After 24 weeks repeat physiologic testing will be performed. We hypothesize that the diet group will experience amelioration of reflux symptoms and require less therapy to control symptoms. An additional aim of this K24 award will be to establish formal training in epidemiology for residents and subspecialty gastroenterology fellows at Temple University Hospital. The curriculum will include didactic lectures supplemented with exercises using statistical software. Investigators from throughout the Temple campus will be introduced to attendees in order to provide opportunities for residents to meet potential mentors. The emphasis of the course will be to provide potential young investigators with a foundation in the performance and analysis of research. PUBLIC HEALTH RELEVANCE (provided by the applicant): This research will help doctors to understand the frequency and risks for esophageal reflux disease (heartburn) in African Americans. The role of obesity and weight loss in the treatment of reflux will be clarified. The study will also give insight into the physical changes in the stomach and esophagus which occur as a result of weight loss in patients with reflux disease.